The document provides guidelines for conducting research on health disaster response. An international panel of experts developed a consensus on research priorities and a mixed-methods approach. The priorities include assessing community preparedness before a disaster and evaluating the response and health impacts after. A mixed-methods approach using both qualitative and quantitative data is recommended to improve the quality of evidence-based research on disaster medicine.
Recent public health emergencies have highlighted the need to better integrate research into emergency response efforts. The authors propose establishing standardized protocols, identifying funding mechanisms, and designating an "incident commander" for research to facilitate studies during emergencies. They discuss challenges conducting research during past events like H1N1 and the BP oil spill. Efforts are underway to address these issues, but more work is still needed to fully realize an integrated research response model.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
1) The study aims to validate an integrated telerehabilitation model to support post-acute coronary syndrome rehabilitation and secondary prevention using mobile technologies and telemonitoring.
2) Patients will be randomized into two groups - a control group receiving conventional in-hospital rehabilitation and an intervention group using a mobile app and telemonitoring for 10 months of at-home rehabilitation.
3) The primary outcome is adherence to exercise measured by questionnaires and exercise tests, with secondary outcomes of cardiovascular risk factor control, lifestyle changes, and cost analysis.
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes outcome measures like functional status, symptom status, patient satisfaction, and quality of life. It also discusses approaches to measuring outcomes, including outcome measures and drug use measures. It provides definitions and explanations of key epidemiological terms used to measure outcomes, such as prevalence, incidence rates, morbidity, mortality, case fatality rates, and survival rates. It also defines various ways to measure drug use, including monetary units, prescriptions, drug units dispensed, defined daily doses, and adherence measurements.
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
Adverse effects of delayed antimicrobial treatment and surgical source contro...Manuel Pivaral
This study analyzed data from a cluster-randomized trial to assess the impact of timing of antimicrobial therapy and surgical source control on outcomes in patients with sepsis. It found that delays in antimicrobial treatment were associated with increased mortality and risk of progression to septic shock. Each hour of delay was associated with a 0.42% increase in mortality. Delays over 6 hours significantly increased mortality. Delay in surgical source control was also associated with decreased success of source control and increased mortality, though these effects were not significant after adjusting for confounders. The results suggest management of sepsis requires timely antimicrobial therapy and source control to optimize outcomes.
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. It involves descriptive studies that ask questions about disease occurrence, magnitude, location, time period, and affected individuals. Analytical studies like case-control and cohort studies are used to test hypotheses about disease causes. Randomized controlled trials experimentally study interventions by applying or withdrawing suspected causes between study groups.
Recent public health emergencies have highlighted the need to better integrate research into emergency response efforts. The authors propose establishing standardized protocols, identifying funding mechanisms, and designating an "incident commander" for research to facilitate studies during emergencies. They discuss challenges conducting research during past events like H1N1 and the BP oil spill. Efforts are underway to address these issues, but more work is still needed to fully realize an integrated research response model.
PERSONALIZED MEDICINE SUPPORT SYSTEM: RESOLVING CONFLICT IN ALLOCATION TO RIS...hiij
Treatment management in cancer patients is largely based on the use of a standardized set of predictive
and prognostic factors. The former are used to evaluate specific clinical interventions, and they can be
useful for selecting treatments because they directly predict the response to a treatment. The latter are used
to evaluate a patient’s overall outcomes, and can be used to identify the risks or recurrence of a disease.
Current intelligent systems can be a solution for transferring advancements in molecular biology into
practice, especially for predicting the molecular response to molecular targeted therapy and the prognosis
of risk groups in cancer medicine. This framework primarily focuses on the importance of integrating
domain knowledge in predictive and prognostic models for personalized treatment. Our personalized
medicine support system provides the needed support in complex decisions and can be incorporated into a
treatment guide for selecting molecular targeted therapies.
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
1) The study aims to validate an integrated telerehabilitation model to support post-acute coronary syndrome rehabilitation and secondary prevention using mobile technologies and telemonitoring.
2) Patients will be randomized into two groups - a control group receiving conventional in-hospital rehabilitation and an intervention group using a mobile app and telemonitoring for 10 months of at-home rehabilitation.
3) The primary outcome is adherence to exercise measured by questionnaires and exercise tests, with secondary outcomes of cardiovascular risk factor control, lifestyle changes, and cost analysis.
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes outcome measures like functional status, symptom status, patient satisfaction, and quality of life. It also discusses approaches to measuring outcomes, including outcome measures and drug use measures. It provides definitions and explanations of key epidemiological terms used to measure outcomes, such as prevalence, incidence rates, morbidity, mortality, case fatality rates, and survival rates. It also defines various ways to measure drug use, including monetary units, prescriptions, drug units dispensed, defined daily doses, and adherence measurements.
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
Adverse effects of delayed antimicrobial treatment and surgical source contro...Manuel Pivaral
This study analyzed data from a cluster-randomized trial to assess the impact of timing of antimicrobial therapy and surgical source control on outcomes in patients with sepsis. It found that delays in antimicrobial treatment were associated with increased mortality and risk of progression to septic shock. Each hour of delay was associated with a 0.42% increase in mortality. Delays over 6 hours significantly increased mortality. Delay in surgical source control was also associated with decreased success of source control and increased mortality, though these effects were not significant after adjusting for confounders. The results suggest management of sepsis requires timely antimicrobial therapy and source control to optimize outcomes.
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. It involves descriptive studies that ask questions about disease occurrence, magnitude, location, time period, and affected individuals. Analytical studies like case-control and cohort studies are used to test hypotheses about disease causes. Randomized controlled trials experimentally study interventions by applying or withdrawing suspected causes between study groups.
Epidemiological statistics and study designs were discussed. The key points are:
1. Epidemiology deals with disease patterns in populations and epidemiological statistics uses sampling and statistical methods for research.
2. The stages of epidemiological investigations are diagnostic, descriptive, investigative, experimental, analytical, intervention, decision-making, and monitoring phases.
3. Major types of epidemiological studies include descriptive epidemiology, observational studies like cohort, case-control, and cross-sectional studies, and experimental randomized controlled trials. Each type has advantages and disadvantages for investigating different research questions.
Declaration of helsinki powerpoint presentationPoojaGupta767
The document summarizes the history and key principles of the Declaration of Helsinki, which establishes ethical guidelines for medical research involving human subjects. It originated in 1964 and has undergone several revisions. The Declaration's goals are to protect research participants and ensure research is justified. Some key principles are that research must have scientific merit and potential benefits outweigh risks, participants must provide informed consent, and special protections apply to biomedical research combined with patient care.
This study evaluated the effectiveness of a semi-tailored facilitator intervention to support implementation of chronic disease management programs in Danish general practices. 189 practices were randomly allocated to receive the intervention in 2011 or 2012. The intervention consisted of up to three one-hour visits from a facilitator to discuss topics related to chronic care. The primary outcome was the number of annual chronic disease checkups per patient. Secondary outcomes included use of diagnostic coding, patient stratification, and other process measures. Results showed no difference between groups for the primary outcome, but some secondary outcomes favored the intervention group, such as higher reported use of diagnostic coding and earlier signup for a patient management software. The authors concluded the low-intensity intervention was unlikely to substantially improve
This document discusses various measures used to quantify drug use and outcomes in pharmacoepidemiological studies. It describes prevalence as the proportion of people with a disease or exposed to a drug at a given time. Incidence is the number of new cases within a time period, while incidence rate is the number of new cases per unit of person-time at risk. Drug use is commonly measured by the number of prescriptions, units of drug dispensed, defined daily doses which estimates average maintenance dose, and prescribed daily doses which is the average dose actually prescribed. Adherence is often measured through biological assays, pill counts, pharmacy records, and patient interviews.
This document summarizes a DNP project that evaluated the implementation of a sedation vacation protocol in a medical intensive care unit (MICU). The purpose was to determine if the protocol reduced pneumonia incidence, intubation duration, and ICU length of stay. A literature review found support for daily sedation vacations, spontaneous breathing trials, and ventilator bundle care. Chart reviews of 33 patients in 2014 found the protocol was ordered for all patients but only documented for 67% of patients. Results were inconclusive on outcomes. Barriers to full protocol compliance were identified.
Epidemiology is the study of the distribution of health related events. It is concerned with epidemic of communicable disease, non communicable infectious disease, chronic disease,maternal-child health, occupational health, environment health etc.
various measures for the measurement of outcome such as incidence prevalence and other drug us measures are briefly discussed here with suitable examples and equations
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems. Some key principles of epidemiology are that it studies incidence and patterns of health issues over time, place and personal characteristics (distribution) and seeks to understand causes and risk factors (determinants). Applied epidemiology aims to monitor diseases, evaluate programs and plan public health resources to deal with a wide range of health issues and keep communities healthy.
Epidemiology is the study and analysis of the patterns, causes, and effects of health, disease & production conditions in defined populations, in terms of space and temporality.
Epidemiology is the study of patterns, causes, and effects of health and disease conditions in populations. It informs public health policy and evidence-based medicine by identifying risk factors and targets for prevention. Epidemiologists help with study design, data collection and analysis, and dissemination of results. Major areas of study include disease etiology, outbreak investigation, disease surveillance, and treatment comparisons in clinical trials. The document then discusses the roles and responsibilities of epidemiologists at the Bureau of Epidemiology in conducting disease surveillance, outbreak investigations, occupational health monitoring, and publishing health reports and data analyses to guide public health efforts.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
The document discusses improving patient safety in intensive care medicine. It describes launching a major initiative through the European Society of Intensive Care Medicine (ESICM) to bring together representatives from critical care societies around the world. The goal is to pledge efforts to improving patient care and outcomes. Key areas of focus include changing medical culture and priorities to better address patient safety issues, and evaluating patient safety at both the individual patient level and collective level to maximize benefits and minimize harms. The initiative aims to raise awareness of patient safety and help transform daily practice to improve quality of care for all patients.
This document reviews strategies to improve surgical outcomes through multimodal perioperative care approaches. It finds that newer perioperative care approaches have reduced both morbidity and mortality in surgical patients. Specifically, it discusses how regional anesthesia, minimally invasive surgery, intraoperative normothermia, and accelerated rehabilitation programs can reduce stress responses and complications after surgery. The major challenge is developing standardized "fast track" surgical programs using multimodal interventions to achieve pain-free and risk-free perioperative courses.
Implementation science studies strategies for adapting and applying evidence-based interventions in real-world settings like schools, workplaces and healthcare facilities to improve population health. This field develops theories of implementation and evaluates measures of implementation success. Methods include stakeholder engagement, effectiveness studies, research synthesis and modeling to identify strategies for integrating evidence-based interventions into programs and policies. For implementation science to reach its full potential, the research paradigm needs to shift toward greater stakeholder input and reporting on external validity to improve relevance and guide decision makers.
This document outlines the educational objectives and content for a lecture on epidemiology. The objectives are to define key epidemiology terms, discuss the functions and modes of epidemiologic investigation, and identify sources of data and potential sources of error. The content includes definitions of epidemiology and related terms, the main functions of epidemiology, descriptive and analytic modes of investigation, how surveillance system data is applied through outbreak investigation, and sources of epidemiological data and potential sources of error.
This document discusses the importance of implementing management tools and techniques in toxicology and poisoning organizations to improve outcomes. It argues that applying concepts from business management can help optimize various parts of the toxicology treatment process. These may include project management, risk management, quality management, and information and communication technologies. The document presents evidence that management approaches have led to positive results in other settings and could similarly enhance the efficacy of poisoning treatment systems if adopted in healthcare toxicology organizations.
The document summarizes the use of electronic health records (EHRs) for syndromic surveillance, using the example of Zika virus. It discusses how EHRs can help improve reporting of outbreaks by recording patient information. While EHRs provide advantages like improved reporting efficiency and criterion validity of data, they also have limitations like the need for diagnostic and demographic accuracy. The document reviews literature on different surveillance systems and their use in various healthcare settings. It concludes by discussing opportunities for further research, such as including new diseases in surveillance systems and improving collaboration between public and private health sectors.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
Apostila e book sus para concursos - 2013nanda_enfe
Este documento apresenta um resumo de um e-book sobre legislação do SUS para concursos públicos. O e-book tem como objetivo facilitar o estudo da legislação do SUS para candidatos da área da saúde, comentando as principais leis e fornecendo exercícios resolvidos. O autor desenvolveu este método após passar em primeiro lugar em concurso público estudando legislação do SUS.
La realidad virtual es un mundo virtual generado por ordenadores en el que el usuario interactúa y se siente inmerso. Existen dos tipos de inmersión: inmersiva, usando cascos y gafas, y semi-inmersiva a través de pantallas. La realidad virtual se usa comúnmente para entrenamiento, medicina, diseño y entretenimiento. Puede ser individual o compartida entre humanos y máquinas.
Epidemiological statistics and study designs were discussed. The key points are:
1. Epidemiology deals with disease patterns in populations and epidemiological statistics uses sampling and statistical methods for research.
2. The stages of epidemiological investigations are diagnostic, descriptive, investigative, experimental, analytical, intervention, decision-making, and monitoring phases.
3. Major types of epidemiological studies include descriptive epidemiology, observational studies like cohort, case-control, and cross-sectional studies, and experimental randomized controlled trials. Each type has advantages and disadvantages for investigating different research questions.
Declaration of helsinki powerpoint presentationPoojaGupta767
The document summarizes the history and key principles of the Declaration of Helsinki, which establishes ethical guidelines for medical research involving human subjects. It originated in 1964 and has undergone several revisions. The Declaration's goals are to protect research participants and ensure research is justified. Some key principles are that research must have scientific merit and potential benefits outweigh risks, participants must provide informed consent, and special protections apply to biomedical research combined with patient care.
This study evaluated the effectiveness of a semi-tailored facilitator intervention to support implementation of chronic disease management programs in Danish general practices. 189 practices were randomly allocated to receive the intervention in 2011 or 2012. The intervention consisted of up to three one-hour visits from a facilitator to discuss topics related to chronic care. The primary outcome was the number of annual chronic disease checkups per patient. Secondary outcomes included use of diagnostic coding, patient stratification, and other process measures. Results showed no difference between groups for the primary outcome, but some secondary outcomes favored the intervention group, such as higher reported use of diagnostic coding and earlier signup for a patient management software. The authors concluded the low-intensity intervention was unlikely to substantially improve
This document discusses various measures used to quantify drug use and outcomes in pharmacoepidemiological studies. It describes prevalence as the proportion of people with a disease or exposed to a drug at a given time. Incidence is the number of new cases within a time period, while incidence rate is the number of new cases per unit of person-time at risk. Drug use is commonly measured by the number of prescriptions, units of drug dispensed, defined daily doses which estimates average maintenance dose, and prescribed daily doses which is the average dose actually prescribed. Adherence is often measured through biological assays, pill counts, pharmacy records, and patient interviews.
This document summarizes a DNP project that evaluated the implementation of a sedation vacation protocol in a medical intensive care unit (MICU). The purpose was to determine if the protocol reduced pneumonia incidence, intubation duration, and ICU length of stay. A literature review found support for daily sedation vacations, spontaneous breathing trials, and ventilator bundle care. Chart reviews of 33 patients in 2014 found the protocol was ordered for all patients but only documented for 67% of patients. Results were inconclusive on outcomes. Barriers to full protocol compliance were identified.
Epidemiology is the study of the distribution of health related events. It is concerned with epidemic of communicable disease, non communicable infectious disease, chronic disease,maternal-child health, occupational health, environment health etc.
various measures for the measurement of outcome such as incidence prevalence and other drug us measures are briefly discussed here with suitable examples and equations
Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems. Some key principles of epidemiology are that it studies incidence and patterns of health issues over time, place and personal characteristics (distribution) and seeks to understand causes and risk factors (determinants). Applied epidemiology aims to monitor diseases, evaluate programs and plan public health resources to deal with a wide range of health issues and keep communities healthy.
Epidemiology is the study and analysis of the patterns, causes, and effects of health, disease & production conditions in defined populations, in terms of space and temporality.
Epidemiology is the study of patterns, causes, and effects of health and disease conditions in populations. It informs public health policy and evidence-based medicine by identifying risk factors and targets for prevention. Epidemiologists help with study design, data collection and analysis, and dissemination of results. Major areas of study include disease etiology, outbreak investigation, disease surveillance, and treatment comparisons in clinical trials. The document then discusses the roles and responsibilities of epidemiologists at the Bureau of Epidemiology in conducting disease surveillance, outbreak investigations, occupational health monitoring, and publishing health reports and data analyses to guide public health efforts.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
The document discusses improving patient safety in intensive care medicine. It describes launching a major initiative through the European Society of Intensive Care Medicine (ESICM) to bring together representatives from critical care societies around the world. The goal is to pledge efforts to improving patient care and outcomes. Key areas of focus include changing medical culture and priorities to better address patient safety issues, and evaluating patient safety at both the individual patient level and collective level to maximize benefits and minimize harms. The initiative aims to raise awareness of patient safety and help transform daily practice to improve quality of care for all patients.
This document reviews strategies to improve surgical outcomes through multimodal perioperative care approaches. It finds that newer perioperative care approaches have reduced both morbidity and mortality in surgical patients. Specifically, it discusses how regional anesthesia, minimally invasive surgery, intraoperative normothermia, and accelerated rehabilitation programs can reduce stress responses and complications after surgery. The major challenge is developing standardized "fast track" surgical programs using multimodal interventions to achieve pain-free and risk-free perioperative courses.
Implementation science studies strategies for adapting and applying evidence-based interventions in real-world settings like schools, workplaces and healthcare facilities to improve population health. This field develops theories of implementation and evaluates measures of implementation success. Methods include stakeholder engagement, effectiveness studies, research synthesis and modeling to identify strategies for integrating evidence-based interventions into programs and policies. For implementation science to reach its full potential, the research paradigm needs to shift toward greater stakeholder input and reporting on external validity to improve relevance and guide decision makers.
This document outlines the educational objectives and content for a lecture on epidemiology. The objectives are to define key epidemiology terms, discuss the functions and modes of epidemiologic investigation, and identify sources of data and potential sources of error. The content includes definitions of epidemiology and related terms, the main functions of epidemiology, descriptive and analytic modes of investigation, how surveillance system data is applied through outbreak investigation, and sources of epidemiological data and potential sources of error.
This document discusses the importance of implementing management tools and techniques in toxicology and poisoning organizations to improve outcomes. It argues that applying concepts from business management can help optimize various parts of the toxicology treatment process. These may include project management, risk management, quality management, and information and communication technologies. The document presents evidence that management approaches have led to positive results in other settings and could similarly enhance the efficacy of poisoning treatment systems if adopted in healthcare toxicology organizations.
The document summarizes the use of electronic health records (EHRs) for syndromic surveillance, using the example of Zika virus. It discusses how EHRs can help improve reporting of outbreaks by recording patient information. While EHRs provide advantages like improved reporting efficiency and criterion validity of data, they also have limitations like the need for diagnostic and demographic accuracy. The document reviews literature on different surveillance systems and their use in various healthcare settings. It concludes by discussing opportunities for further research, such as including new diseases in surveillance systems and improving collaboration between public and private health sectors.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
Apostila e book sus para concursos - 2013nanda_enfe
Este documento apresenta um resumo de um e-book sobre legislação do SUS para concursos públicos. O e-book tem como objetivo facilitar o estudo da legislação do SUS para candidatos da área da saúde, comentando as principais leis e fornecendo exercícios resolvidos. O autor desenvolveu este método após passar em primeiro lugar em concurso público estudando legislação do SUS.
La realidad virtual es un mundo virtual generado por ordenadores en el que el usuario interactúa y se siente inmerso. Existen dos tipos de inmersión: inmersiva, usando cascos y gafas, y semi-inmersiva a través de pantallas. La realidad virtual se usa comúnmente para entrenamiento, medicina, diseño y entretenimiento. Puede ser individual o compartida entre humanos y máquinas.
The document analyzes data from the open star cluster M11 to determine its fundamental properties. Photometry of stars in M11 was performed using images taken through two filters with a telescope. A color-magnitude diagram was created and fit with theoretical models, revealing M11 to be around 250 million years old, located 5930 light years away, and having a similar iron-to-hydrogen ratio as the sun. Analysis of independent star clusters provides insights into patterns of galaxy formation and evolution.
Ring Spinning - flexible shaft couplings for energy management - POLAND 2016Debashish Banerjee
The document discusses ring spinning shaft engineering and proposes using flexible rubber couplings to improve energy management. Flexible couplings absorb kinetic energy from angular deflection in the shafts, minimizing transmission speed losses. This allows spindle speeds over 20,000 rpm with 45% lower energy consumption. Flexible couplings compensate for shaft torsion at coupling points by creating a mirror image of shaft displacement. This lowers the amplitude of shaft distortion and reduces entropy in the system, improving energy efficiency.
This document provides information about purchasing a Site Pro BU254 stainless steel buckle from Launch 3 Telecom. It describes the product, payment and shipping options, warranty, and additional services offered by Launch 3 Telecom such as repairs, maintenance contracts, de-installation, and recycling. Launch 3 Telecom is a telecom equipment supplier and provider of installation and repair services.
This document is a catalog listing various clothing items including shirts, singlets, polos and hats from brands like Arashi, Denki, Natsu, Heiwa, and Boshi. Each item listing includes the name, color, and code. There are a total of 30 unique items listed.
Yarn intelliegnce - decision making in yarn manufacturing on AI platformDebashish Banerjee
1) The document presents an AI-based decision making model for the textile manufacturing value chain to improve process optimization and predict outcomes.
2) It describes using a depth-first and breadth-last heuristic algorithm to evaluate influence variables like fiber properties and machinery settings to classify outcomes and determine influence weights.
3) The model integrates engineering, process, and product performance data in a matrix to help predict the effects of corrective measures and improve productivity by determining optimal work groups.
Este documento presenta una guía de sedación paliativa para profesionales de la salud en las Islas Baleares. La guía establece criterios clínicos y éticos para utilizar la sedación paliativa como tratamiento de síntomas refractarios en la etapa final de vida. La guía fue desarrollada por un grupo de expertos en cuidados paliativos y revisada por otros profesionales. El objetivo es proporcionar orientación para iniciar y administrar la sedación paliativa de una manera que garantice el confort del paciente y respete su
El documento describe los deportes individuales, clasificándolos según cuatro elementos: la participación (simultánea o alternativa), la oposición (con o sin adversario), el espacio (común o separado), y el uso de implementos. Se presenta una tabla de clasificación de los deportes individuales según estos cuatro elementos, incluyendo ejemplos de deportes para cada categoría.
This document presents a presentation on master planning. It defines a master plan as a general plan for the future layout of a city showing existing and proposed infrastructure. The objectives of a master plan are to intelligently spend public funds for public welfare, arrange the town pattern to satisfy present needs without compromising the future, and restrict unplanned growth. Developing a master plan is a lengthy process that involves collecting data, drafting a plan, soliciting public comments, revising the plan, and determining the implementation sequence. Execution of the plan is carried out in stages by the local authorities to fit improvements into the overall vision. A well-prepared master plan can ensure the harmonious and proportional development of a town over time.
The important role of the Department of Defense in the US's policies regarding Puerto Rico: the restructuring of debt is just an excuse to increase the DoD's activity in Puerto Rico
Michaela Meade has over 10 years of experience as a media planner and buyer. She has worked for various advertising and media companies in Las Vegas, developing media plans and negotiating deals. She is proficient in media planning tools and has a track record of delivering results, most recently increasing ticket sales ROI by 38% for an MGM Resorts attraction.
This document is a blog post presenting 10 phrasal verbs in English: go out, call off, take up, turn down, break into, pick up, turn on, turn down, get up, and turn out. For each phrasal verb, the post provides the definition, part of speech, and an example sentence to illustrate its meaning. The post was written by Lorena González for an English class assignment at UNAD University in Colombia in 2016.
The document discusses the author's experience processing archival collections and provides tips for archival work. It outlines Stefanie Caloia's processing experience with the Reuther Library and History Associates, and describes using an Excel box-inventory template and folder fastening techniques. The document also includes links to photos related to archival work and festivals.
El pueblo de Bernal se encuentra a 57 km de la capital de Querétaro y al pie de La Peña de Bernal, un enorme monolito. La Peña de Bernal fue fundada en 1647 por soldados vascos y actualmente tiene 6000 habitantes, aunque los fines de semana recibe muchos visitantes deseosos de ver este fenómeno natural. La Peña también ofrece opciones para escalada y alojamiento cerca en Tequisquiapan.
This systematic review examined 17 peer-reviewed studies from 2006-2016 that measured nurses' preparedness for disaster response. The review found that previous disaster response experience and disaster-related training increased nurses' preparedness. However, most studies reported that nurses felt insufficiently prepared and not confident in their ability to effectively respond to disasters. The findings suggest that nurse educators and administrators should do more to prepare nurses through policies, training, and disaster simulation exercises.
30 Volume 82 • Number 1A D V A N C E M E N T O F T H E .docxlorainedeserre
30 Volume 82 • Number 1
A D V A N C E M E N T O F T H E PRACTICEA D V A N C E M E N T O F T H E PRACTICE
D I R E C T F R O M C D C E N V I R O N M E N T A L H E A L T H S E R V I C E S
I ntroductionEmergency response and recovery work-ers might be exposed to multiple hazard-
ous conditions and stressful work environ-
ments when responding to a public health
emergency. Previous emergency events have
demonstrated that significant gaps and defi-
ciencies in responder health and safety con-
tinue to exist (Michaels & Howard 2012,
Newman, 2012). Ensuring the health and
safety of emergency response and recovery
workers who might be exposed to hazardous
conditions and stressful work environments
when responding to a public health emer-
gency should remain a top priority (Kitt et al.,
2011). The National Response Framework
contains a Worker Safety and Health Annex
detailing responsibilities for safety and health
during major emergencies, including roles
for the National Institute for Occupational
Safety and Health (NIOSH) such as exposure
assessment and personal protective equip-
ment determination.
The NIOSH Emergency Preparedness
and Response (EPR) Program was created
in 2002 following the events of 9/11, which
included attacks on the World Trade Center
and Pentagon, and the anthrax letter terrorist
attacks. The goal of the NIOSH EPR Program
is to coordinate emergency preparedness
and response within NIOSH and improve
NIOSH’s ability to respond to future emergen-
cies and disasters. The NIOSH EPR Program
protects the health and safety of emergency
response and recovery workers through the
advancement of research and collaborations
to prevent diseases, injuries, and fatalities in
anticipation of and during responses to natu-
ral and human-induced disasters and novel
emergent events.
The NIOSH EPR Program participates in
response planning at the local, state, national,
and international levels to ensure the timely
identification of health hazards associated
with emergency responses and implementa-
tion of adequate protection measures; support
the Centers for Disease Control and Preven-
tion’s (CDC) emergency response efforts; and
use the Disaster Science Responder Research
Program to identify research needs to protect
emergency response and recovery workers
while identifying solutions to rapidly support
research during emergencies. Training for
emergency response and recovery workers is
an integral part of the NIOSH EPR Program.
This column highlights the NIOSH EPR Pro-
gram training opportunities and activities.
E d i t o r ’s N o t e : NEHA strives to provide up-to-date and relevant
information on environmental health and to build partnerships in the
profession. In pursuit of these goals, we feature this column on environmental
health services from the Centers for Disease Control and Prevention (CDC)
in every issue of the Journal.
In these columns, authors from CDC’s Water, Fo ...
30 Volume 82 • Number 1A D V A N C E M E N T O F T H E .docxBHANU281672
30 Volume 82 • Number 1
A D V A N C E M E N T O F T H E PRACTICEA D V A N C E M E N T O F T H E PRACTICE
D I R E C T F R O M C D C E N V I R O N M E N T A L H E A L T H S E R V I C E S
I ntroductionEmergency response and recovery work-ers might be exposed to multiple hazard-
ous conditions and stressful work environ-
ments when responding to a public health
emergency. Previous emergency events have
demonstrated that significant gaps and defi-
ciencies in responder health and safety con-
tinue to exist (Michaels & Howard 2012,
Newman, 2012). Ensuring the health and
safety of emergency response and recovery
workers who might be exposed to hazardous
conditions and stressful work environments
when responding to a public health emer-
gency should remain a top priority (Kitt et al.,
2011). The National Response Framework
contains a Worker Safety and Health Annex
detailing responsibilities for safety and health
during major emergencies, including roles
for the National Institute for Occupational
Safety and Health (NIOSH) such as exposure
assessment and personal protective equip-
ment determination.
The NIOSH Emergency Preparedness
and Response (EPR) Program was created
in 2002 following the events of 9/11, which
included attacks on the World Trade Center
and Pentagon, and the anthrax letter terrorist
attacks. The goal of the NIOSH EPR Program
is to coordinate emergency preparedness
and response within NIOSH and improve
NIOSH’s ability to respond to future emergen-
cies and disasters. The NIOSH EPR Program
protects the health and safety of emergency
response and recovery workers through the
advancement of research and collaborations
to prevent diseases, injuries, and fatalities in
anticipation of and during responses to natu-
ral and human-induced disasters and novel
emergent events.
The NIOSH EPR Program participates in
response planning at the local, state, national,
and international levels to ensure the timely
identification of health hazards associated
with emergency responses and implementa-
tion of adequate protection measures; support
the Centers for Disease Control and Preven-
tion’s (CDC) emergency response efforts; and
use the Disaster Science Responder Research
Program to identify research needs to protect
emergency response and recovery workers
while identifying solutions to rapidly support
research during emergencies. Training for
emergency response and recovery workers is
an integral part of the NIOSH EPR Program.
This column highlights the NIOSH EPR Pro-
gram training opportunities and activities.
E d i t o r ’s N o t e : NEHA strives to provide up-to-date and relevant
information on environmental health and to build partnerships in the
profession. In pursuit of these goals, we feature this column on environmental
health services from the Centers for Disease Control and Prevention (CDC)
in every issue of the Journal.
In these columns, authors from CDC’s Water, Fo.
Intensive Healthcare Facilities and Rooms.pdfbkbk37
1) Pandemic preparedness in healthcare facilities is important to minimize the impact and spread of pandemics.
2) Current healthcare facilities are often underprepared with inadequate equipment, supplies, and training to effectively respond to pandemics.
3) Developing comprehensive pandemic preparedness policies and strategies can help healthcare workers obtain necessary resources to fight pandemics and save lives.
Be it with regard to natural, accidental or intentional means, public health has always been under threat. As is the case with the current COVID 19 pandemic, public health preparedness to prevent, respond to and recover is key for securing country’s overall development and growth.
Effectiveness of the nursing educational program upon nurse's knowledge and p...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
N 599 Aspen University Wk 4 Intensive Healthcare Facilities and.pdfbkbk37
This document discusses pandemic preparedness in acute healthcare facilities. It describes how pandemics can overwhelm healthcare systems if facilities are not properly prepared. Key aspects of preparedness discussed include having adequate isolation capabilities and beds, sufficient staffing levels, and a strategy for quickly developing and distributing vaccines to healthcare workers. The document emphasizes that a multidisciplinary, coordinated effort between all stakeholders is needed for effective pandemic containment.
ECDC supports preparedness efforts in three main ways:
1. By identifying and disseminating best practices in preparedness planning through literature reviews, case studies, and tools.
2. By building national preparedness capacities through workshops, training, and supporting the development of specific capabilities.
3. By fostering interoperability between country preparedness plans and promoting multi-sectoral cooperation to address cross-border health threats.
Intensive Healthcare Facilities and Rooms Capstone.pdfbkbk37
This document discusses the importance of pandemic preparedness in intensive healthcare facilities. It outlines that most acute healthcare settings currently have inadequate guidelines, poor staff training, lack of disaster preparedness plans, and insufficient equipment. The document emphasizes that pandemic preparedness is crucial to ensure healthcare systems can continue operating during a pandemic and minimize its economic and social impacts. It also stresses the need for collaboration across public and private sectors to strengthen infrastructure and policies to effectively fight pandemics.
The document describes how the CDC's Science Impact Framework can be used to measure the impact of scientific work beyond just citation data. It provides three case studies that will illustrate how the framework can be applied. The framework uses a combination of quantitative and qualitative indicators to measure outcomes across five levels of influence: disseminating science, creating awareness, catalyzing action, effecting change, and shaping the future. The case studies will demonstrate how scientific work can have a complex path of impact that does not necessarily follow a linear progression through these levels of influence.
Pandemic Readiness in The Acute Health Care Setting.pdfbkbk37
This document outlines a proposed capstone project on pandemic readiness in acute health care settings. The project aims to investigate levels of pandemic preparedness through examining personal protective equipment conservation, testing site availability and education protocols. A cohort study design will assess pandemic management plans at local hospitals through questionnaires. The project seeks to identify gaps in policies and planning to inform improvements for responding to future pandemics.
The document discusses epidemiology and its applications. It defines epidemiology and describes its purposes such as preventing and controlling health problems. It outlines epidemiological methods like observational and experimental studies. Descriptive epidemiology aims to study disease frequency and distribution while analytical epidemiology tests hypotheses. The roles of nurses in applying epidemiological concepts to assess community health needs and evaluate prevention programs are also highlighted.
Updated copy (introductio to environmental epidemiology & bio statistics)Nasiru Ibrahim Barda
This document provides an overview of environmental epidemiology and bio-statistics. It defines epidemiology as dealing with the incidence, distribution, and possible control of diseases and other factors relating to health in populations. Environmental epidemiology specifically studies how environmental exposures impact human health. The objectives of epidemiology are described as public health surveillance, field investigation, analytic studies, evaluation, and policy development. Environmental epidemiology aims to identify environmental hazards, populations exposed, exposure levels, health impacts, and approaches to reduce exposures.
The Combined Predictive Model final report describes a new predictive model that was developed using data from multiple sources, including inpatient, outpatient, emergency room, and primary care records. This model segments patients into risk levels and can help the NHS target interventions appropriately based on patients' predicted risk levels. It improves on previous models by identifying a broader range of at-risk patients and allowing for stratified approaches along the continuum of care. The report concludes the model can help design long term condition programs that match intervention intensity to patients' needs.
This guideline provides evidence-based recommendations for the management of bleeding in major trauma patients. It has been updated from a previous version published in 2007 based on a systematic review of new evidence. Key changes include new recommendations on coagulation support, monitoring, and the use of local hemostatic measures, tourniquets, calcium, and desmopressin. The recommendations are graded based on the quality of supporting evidence. The guideline aims to improve outcomes for critically injured bleeding trauma patients through a multidisciplinary approach.
Epidemiology is the study of patterns of disease and health conditions within populations. It identifies risk factors for disease and informs public health policy and clinical practice. Epidemiologists conduct descriptive and analytical studies to understand disease distribution and determinants. They help with study design, data analysis, and disseminating results. The bureau of epidemiology conducts epidemiological studies to protect public health from infectious and environmental diseases and conditions. It investigates outbreaks and conducts surveillance of reportable diseases to implement control measures.
Epidemiological trends and health care implicationsania aslam
Epidemiology is the study of patterns, causes, and effects of health and disease conditions in defined populations. It informs public health policy and evidence-based medicine by identifying risk factors and targets for prevention. Epidemiologists conduct descriptive and analytical studies to understand disease distribution and determinants. They help with study design, data analysis, and dissemination of results. The bureau of epidemiology conducts epidemiological studies to protect public health from infectious and environmental diseases. It investigates outbreaks, conducts disease surveillance, and develops prevention strategies.
This document provides guidance on conducting rapid risk assessments of potential public health threats. It outlines a 5-stage methodology: 1) collecting initial event information, 2) performing a literature search, 3) extracting relevant evidence, 4) appraising evidence quality, and 5) estimating risk level. When limited evidence is available, expert knowledge can be used if clearly documented. The guidance emphasizes transparency, explicitness, and updating assessments as new evidence emerges. Advance preparation, such as protocols and expert contact lists, allows more efficient risk assessment in emergencies. The methodology structures the identification and evaluation of evidence to systematically estimate health risk magnitude.
This document provides operational guidance for conducting rapid risk assessments of communicable disease threats. It describes a step-by-step methodology comprising six stages: 1) collecting event information, 2) performing a literature search, 3) extracting relevant evidence, 4) appraising the evidence, 5) estimating the risk, and 0) preparation. The risk is determined by probability of transmission and impact of disease, which are based on the infectious agent and incident details. A qualitative approach is recommended given limited time and information. Transparency is important at each stage. Advance preparation helps ensure threats are effectively addressed. The guidance aims to standardize the rapid risk assessment process.
1. 1
SPECIAL REPORT
Challenges in the Conduct of Health Disaster Response Studies:
Consensus Statement by the Task Force for Quality Control of
Disaster Management (TFQCDM)
Knut Ole Sundnes, MD Chair, Head of Anaesthesia, Norwegian Armed Forces Joint Medical Services;
Co-Chairs: Dag Hjelle, MD, Brigadier General and Director Norwegian Armed Forces Joint Medical
Services; Ernesto A. Pretto, JR. MD, MPH, Professor of Clinical Anesthesiology, University of Miami
Miller School of Medicine; Edmund M. Ricci, PhD Professor, Graduate School of Public Health,
University of Pittsburgh;
Jeffrey Arnold, MD, Chief Medical Officer Santa Clara Valley Health and Hospital System, Santa Clara
County, California, US; Yasufumi Asai, MD Emeritus Professor, Sapporo Medical University, Japan
Special advisor of Japan Disaster Relief (JICA) and Editor in Chief of Journal of Japan Association of
Disaster; Robert Balazs, MD Lt. Col Technical Officer (Medical) NATO Operational Logistics Planning
and Support Programme Office; Per Morten Boelstad Lt Col. Safety inspector (Infantry) Norwegian
Armed Forces joint medical services/risk, safety, preparedness and vulnerability; Felipe Cruz Vega, MD,
Mexican Institute of Social Security, Special Health Projects Division; Siddarth David Senior Research
Officer, School of Habitat Studies, Tata Institute of Social Sciences (TISS), Mumbai; Michel DeBacker
MD, Prof. Dr. Director, Disaster Medicine Unit Research Group on Emergency and Disaster Medicine,
Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Laarbeeklaan, Belgium; Hon. Emmanuel
de Guzman, Philippine Climate Change Commissioner, Philippine climate Change Commission, San
Miguel, Manila, 1005 Philippines; S.William A. Gunn, MD Former Director Emergency Humanitarian
Operations, WHO, Geneva and member Academic Council of the United Nations System; Christian
Haggenmiller, MD; Omar Juma Khatib, MD; Leo Klein, MD Assoc. Prof. Brigadier General MD.,
PhD, Former Surgeon General of the Czech Armed Forces, Dept. of Military Surgery, Faculty of Military
Health Sciences, University of Defence, Charles University Teaching Hospital, Czech Republic; Istvan
Kopcso Brigadier General, Dr, PhD Medical Advisor Supreme Headquarters Allied Powers Europe
Belgium; Isidore K. Kouadio, MD, PhD, FETP, DMHA Regional Polio Certification Officer Global
Polio Eradication Initiative, WHO Regional Office for Africa, Brazzaville, Republic of Congo; Håkon
Lund, MD, Lt Col ,Seniorrådgiver and Senior Staff Officer, Norwegian Armed Forces Medical
Services; Ove Njå PhD Prof. University of Stavanger; Nobhojit Roy, MB, Prof & Head of Surgical
Services and Scientist 'G' BARC Hospital (Govt. of India), HBNI University, Mumbai; Sidika Tekeli,
MD Asst. Prof. Dr. Head of Department Hacettepe University Institute of Public Health Department of
Health Management in Disasters, Turkey; Andreas Ziegler, MD MSc EMDM MBA, Vienna Municipal
Ambulance Service.
Please address correspondence to:
Knut Ole Sundnes MD, (kosundnes@gmail.com) and
Ernesto A Pretto, Jr. MD, MPH (eapretto@med.miami.edu)
2. 2
ABSTRACT
Background: A goal of disaster medicine is the conduct of studies to enable evidence-based learning
that will translate into prevention or reduction of the adverse effects of a disaster on human health and
the health system infrastructure. However, there is no consensus on priorities or best practice
methodology for disaster studies. In this report an international panel of public health experts and
disaster medicine practitioners identifies priorities and proposes solutions concerning the design and
conduct of such studies.
Methods: Interdisciplinary members of the Task Force for Quality Control of Disaster Management
conducted field studies after numerous large-scale disasters. We convened a series of workshops with
public health researchers and disaster medicine practitioners to analyze the literature and deconstruct the
health and medical aspects of disaster response to achieve consensus on priorities and methodology for
disaster response research.
Findings: We have identified research priorities and proposed guidelines for a consensus on the
adoption of a ‘mixed methods’ approach to broaden the scope and improve the quality of evidence-
based research in disaster medicine.
Interpretation: A universal consensus on study priorities and mixed-methods approach to disaster
medicine research will improve data collection and facilitate the uniform reporting of data for creation
of data banks and registries for comparison of all hazard disaster types. This will improve the scientific
rigor of disaster research to better enable the translation of evidence-based knowledge into cost-effective
programs for the prevention and mitigation of human suffering in all-hazard events.
INTRODUCTION
Disaster medicine is a newly emerging and interdisciplinary medical specialty. It is comprised of
two major domains within health care, emergency public health (EPH) and emergency medical services
(EMS). Each domain is characterized by a series of health and medical services delivered to a disaster-
impacted population. In many countries these activities are conducted according to a pre-conceived plan
and well-elaborated disaster response framework, which includes a concept of operations and detailed
descriptions of emergency support functions 1. A disaster response evaluation study is defined as a
scientific endeavor to gather evidence to elucidate the causes, circumstances, risk factors and extent of
3. 3
human and health system damage during the life cycle of a disaster (Fig 1). A major goal of such
studies is the conduct of assessments of the quality of life-saving and life-supporting actions
implemented during and after a disaster in order to improve response to future disasters. However, this
task has not been carried out in an optimal manner to date due to the complexities of performing
research during or after a disaster 2.
In this monograph an international panel of experts recognized as the ‘Task Force for Quality
Control of Disaster Management (TFQCDM)’ describe guidelines for the study of disaster. These
guidelines comprise consensus on priorities and on a combined retrospective methodological approach
we consider to best facilitate evidence-based data collection within the complex interdisciplinary
framework of emergency public health and disaster response. We have concluded that a combination of
evaluative and epidemiological methods blended into a ‘mixed methodology’ is the ideal study design
for disaster research. A mixed methods approach can be defined as:
“…focus on collecting, analyzing, and mixing both quantitative and qualitative data in a
single study or series of studies. Its central premise is that the use of quantitative and qualitative
approaches in combination provides a better understanding of research problems than either approach
alone.” 3,4
The challenge is to know which tools to apply, when, and for what priorities of study so as to
ensure ‘lessons learned’. The guidelines we have developed are based on experiences gained during
field survey studies of large-scale disasters during the period 1989-2005 5-19. After each study the scope
and the methodology were expanded to incorporate elements of both evaluation and epidemiological
research in order to increase the generalizability, applicability and scientific rigor of the methods. To
complement experiences gained in these early studies a series of workshops were convened with public
health researchers and practitioners to systematically deconstruct health and medical activities
commonly performed in the response to disasters and to identify research priorities and the most
4. 4
appropriate methodology to achieve study objectives. A critical analysis of previous disaster studies was
crucial to the process of establishing priorities and selecting a standard methodology. The result of these
efforts is a set of guidelines for evaluation and research of disaster response in the ‘Utstein Style’.
The Utstein Style guidelines format was selected because it provides a structured framework
consisting of templates (standardized forms) and registries (databases) for the uniform reporting of data
to compare disaster responses 20. A first volume of 3 planned volumes of these guidelines has been
published previously describing consensus on terminology and concepts: ‘Conceptual framework of
disasters’ 21. A second published volume describes consensus on the concept of operations: ‘Structural
Framework, Operational Framework and Preparedness,’ 22. The 3rd volume in this consensus project
will focus on ‘Methodology’. An abbreviated description of that methodology is presented herein for
review and feedback.
STUDY PRIORITIES
Pre-Event Phase:
A scientific assessment of the severity of impact of a disaster on a community cannot be fully realized
unless we can collect baseline data on community-wide all-hazard risk planning and preparedness prior
to the event under study, as follows:
The level of awareness about known hazards by the population at risk.
An assessment of the degree of socio-economic development of the community and especially of
the health system, its infrastructure and the types and extent of access to health care services
available to members of the community on an everyday basis. [The assessment of pre-event
status is facilitated by the use of selected World Health Organization (WHO) standard population
health indicators (Table 1)]
5. 5
An assessment of the structure, organization, adequacy and investments in disaster planning and
preparedness programs, and the extent to which these were implemented or tested and achieved
stated objectives during actual and/or simulated events.
6. 6
Table 1. Template for Assessment of Pre-Event Status Basedon SelectedIndicators of Pre Event
Socio-Economic Development and the Post DisasterSeverity Score (DSS).
____________________________________________________________________________________
Checklist:
Indicator of Socio-economic Development *Range
GDP/per capita income (current U.S.$) Low Middle High
Real GDP Growth (%) Low Middle High
Proportion of population rural/urban Low Middle High
Under 5 Infant mortality rate Low Middle High
Maternal mortality rate Low Middle High
Life expectancy Low Middle High
Literacy rate Low Middle High
Proportion of population cell phones/1000 Low Middle High
Proportion of homeless population Low Middle High
Number of residential structures Low Middle High
Number of office buildings Low Middle High
Number of hospitals Low Middle High
Number of vehicles in use/1000 Low Middle High
Annual energy consumption (eq. Kg of oil/capita) Low Middle High
____________________________________________________________________________________
Pre-Event Development Score:
* The range of the score prior to the event is based on the total sum for each category: Middle (average among nations):
Low = 5 points(poorly developed);Middle = 10 points (Average development);High = 15 points (highly developed) .The
change in score before vs after the disasterprovides an estimate of the severity of the disaster on the socio-economic
development of the affected community..
Event Phase:
Once the event has impacted a population we can attempt a study to determine the degree of damage to
the health and health system within the affected community (Table 2). The disaster study should aim to
assess human damage and the extent of disruption or destruction of the health system infrastructure. The
ideal timing for such studies is immediately after the end of relief and response activities. Evaluative
study tools are essential to collect administrative, medical record and interview data from survivors and
responders on the quality of overall life-saving activities implemented during the event. For each
activity the following categories of information must be collected:
7. 7
The structure, process, adequacy, timeliness, outcomes and costs of the damage and of the needs
assessments performed on the disaster-impacted community or society; and the process, and
cost-efficiency of supplying those needs from within the affected community (local response) or
from without (external response).
The identification, prioritization and process of implementation of the emergency relief function
The structure, process, adequacy, timeliness, outcomes and costs (and possible opportunity costs)
of the delivery and management of the health and medical response
The outcomes of specific public health and medical interventions to prevent or reduce morbidity,
mortality and disability among disaster impacted victims as determined by pre-established
standard-of-care end points, as well as the ability or inability of the impacted health system to
provide health services to survivors during the event (triage, application of first aid, emergency
transport, definitive care, potable water, epidemiological surveillance, etc.)
Table 2. Template for Assessment of Pre- and Post-Event Health Status/Health Disaster
Severity Score (HDSS)
____________________________________________________________________________________
Checklist:
Indicator of Health System Development *Range (Before/After)
_____________________________________________________________________________________
Human Impact:
Affected Population: # # #
Crude Mortality Rate/10,000 # # #
Crude Injury Rate/10,000 # # #
Health System infrastructure:
Number and type of hospitals/capita* Low Middle High
Number of beds/capita Low Middle High
Number of health care workers/capita* Low Middle High
Number of Critical Care beds Low Middle High
Average ICU bed occupancy rates (Past 6 months) Low Middle High
Number of Ambulances/EMS systems Low Middle High
Percent population with access to potable water Low Middle High
_____________________________________________________________________________________
8. 8
Health Disaster Severity Score: each indicator is given an arbitrary point score – Low (5) - Middle (10) – High
(15).The change in the score (before vs. after) is an estimate of the severity of damage sustained by the health
system infrastructure (Health Disaster Severity Score).
Post-Event Phase:
A major priority of the study is the assessment of how the affected community recovered from the event.
The priorities during the rehabilitation/recovery phase include the following:
Identification, prioritization, timing of initiation and implementation of relief and recovery
projects, and whose aim is the resumption of the normal activities of daily living [lifelines
(electricity, water, gas, shelter, food distribution, transportation, communication)], as well as the
resumption of normal health services, school, work and leisure activities
Assessment of the health and medical care costs to restore health care services and for the long
term rehabilitative care of the mentally and physically disabled caused by the disaster itself
Assessment of the organization, coordination, sources of funding, costs and adequacy of plans to
reconstruct societal infrastructure (hospitals, roads, bridges, housing, schools, entertainment
facilities, parks, etc.)
Study Designand Methods
We propose consensus on the adoption of a mixed method design for evidence-based research on health
and medical response efforts in a disaster. The study tools employed whether evaluative or
epidemiological are based on the questions asked and the character of the information to be obtained
(qualitative vs. quantitative) and the objectives and specific aims of the study according to the following
considerations: 1) Evaluative methods gather information to be used to assess the quality of the medical
and public health services and interventions deployed using pre-established measures of effectiveness
9. 9
and/or quality indicators and outcome parameters 23-28. 2) Epidemiological research methods are used to
collect concurrent or retrospective quantitative data primarily about the fate of casualties. Whenever
possible data collection instruments must be designed a priori to facilitate uniform reporting of data for
input into data banks and registries that can be used for hypothesis testing (Table 3). Also, the study
design must provide a mechanism for concurrent data collection, which will serve a dual role: a) to
monitor the quality of delivery of services during the event and; b) for risk factor analysis in
retrospective case control studies after the event.
With regard to the implementation of the study, the first phase should involve the following
thought process: 1) identification of the problem(s) to be studied; 2) formulation of the questions or
hypotheses based on the problems identified, and; 3) validation of the research questions through
substantial literature and background research. A primary objective of the study must be to uncover risk
factors for adverse health effects of hazards, in addition to the utility and effectiveness of interventions
employed to prevent or reduce injury or death.
As in any investigative process the findings are only as good as the research questions asked and the
methods used to collect reliable data to answer them. Evaluative tools (eg. survey methodology) are
applicable for the collection of information from key target audiences who participated in the
organization or delivery of the relief and response and to define the parameters of the quality of those
activities according to standard evaluation categories 23,24. The following are sample questions to be
asked of eyewitnesses in health disaster studies:
What was the hazard type?
What was its intensity (Richter scale, Saffir-Simpson wind scale, etc.)?
What was the population at risk?
10. 10
What were the demographic features of the affected population (age, gender) or other important
characteristics?
Were there secondary disasters (fires, dam burst, landslides, etc.)
Was there early warning of the hazard or early warning systems employed?
How well did early warning systems function?
When and how did victims become identified for care?
What types of medical care/surgical procedures were provided to each victim?
Who provided the care (lay bystanders, search and rescue, paramedics, physicians, etc.)?
What was the outcome or the result of the care provided?
What factors worsened the outcome with regard to injury, death or disability?
Was the care provided in a timely manner and appropriate for the various injury conditions?
Were the interventions appropriate for the identified needs?
How many people required temporary shelters?
In addition disaster research is employed to investigate morbidity and mortality statistics (descriptive),
incidence and prevalence of injuries, and exposure response for the determination of risk factors for
illness, injury and death 28. The following are a sample of health data for quantitative analysis and
hypothesis testing that are usually collected within the context of a mixed methods health disaster study:
What were the injury types according to cause and mechanism (crush, drowning, burn, traumatic
brain injury, malnutrition, etc.)
Injury type according to anatomic region (head, neck, thorax, extremities)
Circumstances of injury or death (building collapse, entrapment, flooding, fire, explosion,
drought, etc.)
11. 11
Mechanism and pattern of dying (asphyxiation, exsanguination, hemorrhagic shock, ventricular
fibrillation cardiac arrest, hypothermia, starvation, etc.)
What was the severity of injuries (Injury severity scores)?
Timing of death (instant, delayed, protracted)
Location of injury or death (inside or outside of a building, out-of-hospital, during transport, in-
hospital, etc.)
Types and quantity of medical/surgical interventions employed (extrication, fluid resuscitation,
basic or advanced trauma life support, resuscitative surgery, amputations, etc.), if possible by
ICDM-10 codes.
Types of disabilities?
Epidemiological methods can be combined with evaluation methods to assess the influence of first
aid training on relief efforts using inferential statistical analyses 9. Case-control methodology has been
used since the 1970s to identify risk factors based on differences in circumstances between populations
of injured and uninjured at the time of disaster impact 29-38. Prospective randomized clinical trials have
not been reported in disaster situations due to the unpredictable nature of disasters.
Table 4. Template for Concurrent Data Collection on DisasterCasualties
____________________________________________________________________________________
Name
Age (if known)
Date of birth (if known)
Gender
Numeric identifier/bar code
Date of injury
Date and time the victim was identified
Location of the victim when injured
Distance to treatment facility
Mode of transportation to the treatment facility
Distance to food sources
12. 12
Distance to potable water/water source
Preliminary diagnosis or cause of injury/illness
Type of treatment(s) provided at the scene of injury, during transport, and in-hospital
Triage status of the victim on arrival to the treatment facility (EG. walking wounded, urgent, critical, dead on
arrival)
________________________________________________________________________________________
Discussion
We propose a consensus for the study of disaster response based on previous experiences in disaster
studies and on a systematic analysis by public health experts and practitioners on the priorities for study
and best methodology for disaster response research 3,4. There are many benefits that should accrue with
the prioritization of the objectives and the systematic application of standardized research methods for
the study of disaster 39. These guidelines provide purpose and structure and a detailed road map for the
formulation of questions and hypotheses, identification of sources of data, and data collection templates
in disaster situations. It also provides guidance on when and how to apply a mixed methodological
approach. In addition, the structure and processes of the methods are generic enough to have
applications in other domains within the broader disaster field. Its proper application by trained teams
should result in increasing validity of the findings and enhanced reproducibility and generalizability
applicable to all-hazards disaster research.
The practical application of these consensus guidelines should result in evidence-based findings, and
conclusions and recommendations to enhance the cost-effectiveness of the medical responses to
disasters and their outcomes. Ongoing use of the processes outlined and the uniform reporting of data
using standardized checklists and templates should facilitate the creation of data banks and registries to
inform disaster planners as they review and revise existing disaster preparedness programs and
interventions in anticipation of future disasters.
13. 13
Further development of the guidelines will include a consensus on a set of key indicators or best
practices for each activity. Once the indicators have evolved, a set of measurements and potentially
critical pathways should develop for each of the indicators. Ultimately, appropriate benchmarks will
evolve and be tested using select indicators and methods for measurement. Once this is achieved, real
quality monitoring capabilities will be in place. Numerous examples of tools for use in rapid needs
assessment serve as models.
There are several limitations to the methodology presented. A primary limitation of
retrospective data collection is that much of the needed information is not documented or may be
inconsistent. Also, information collected from individuals is subject to recall bias and is perishable.
Perishable data change with the passage of time and consequently their value also decreases with the
passage of time. In fact, much of the interview data obtained in or following disaster situations is subject
to change by many confounding factors such as the influence of media reports, and the sharing of
information between victims, between responders, and between others involved in the care delivered to
the victims. Thus, for certain data, the time selected for data collection is crucial. Despite these
limitations an attempt is made to reconstruct the events from data collected from individuals within the
affected population namely, uninjured survivors, injured survivors and data on non-survivors. Another
source of information is the group of individuals who were involved in the relief effort. These subgroups
are primary sources of data collection.
In conclusion, this consensus paper is meant to raise awareness among the general medical and
humanitarian relief communities about an approach that will lead to an increased scope and
systematic evidence-based study of disaster. We hope that the publication of this paper will lead
to a debate within academic circles that will lead to a better understanding of the challenges of
this particular area of research.
14. 14
References
1. http://www.fema.gov/national-response-framework
2. Yeskey K, Miller A. Science Unpreparedness. Disaster Medicine and Public health
Preparedness. 2015 9(4): pp 444-445.
3. Creswell, J. W. (1999). Mixed-method research: Introduction and application. In G.Cizek
(Ed.), Handbook of educational policy. San Diego, CA: Academic Press
4. Creswell, J. W., Goodchild, L., & Turner, P. (1996). Integrated qualitative and quantitative
research: Epistemology, history, and designs. In J. Smart (Ed.), Higher education: Handbook
of theory and research (Vol. 11, pp. 90–136). New York: Agathon Press. Understanding
Mixed Methods Research
5. Klain M, Ricci E, Safar P, Semenov V, Pretto E, Tisherman S, Abrams J, Comfort L: Disaster
Reanimatology Potentials: a structured interview study in Armenia I. Methodology and
Preliminary results. Prehospital and Disaster Medicine. 1989; 4:135-152.
6. Ricci E, Pretto E, Safar P: Disaster Reanimatology Potentials: A structured interview study in
Annenia II. Method for Evaluation of Medical Response to Major Disasters. Prehospital and
Disaster Medicine 1991;6(2):159-166.
7. Pretto E, Ricci E, Safar P, et al: Disaster Reanimatology Potentials: A structured interview study
in Armenia Ill. Final Results, Conclusions and Recommendations. Prehospital and Disaster
Medicine 7(4):327-338, 1992.
8. Pretto E, Angus D, Abrams J, et al: An Analysis of Prehospital Mortality in an Earthquake.
Prehospital and Disaster Medicine 9 (2):, 1994.
9. Angus D, Pretto E.A., Abrams J. Epidemiological assessment of mortality, building collapse
pattern and medical response after the 1992 Earthquake in Turkey. Prehosp Disaster Medicine
1997; 12(3): 49-58.
10. Pretto E, Begovic M, Begovic M. Emergency Medical Services During the Siege of
Sarajevo. Prehospital and Disaster Medicine 9(2):, 1994.
11. Angus D, Pretto EA, Abrams JI, Safar P: Recommendations for Life-Supporting First
Aid Training of the Lay Public for Disaster Preparedness. Prehospital and Disaster
Medicine 8(2):1993.
12. Abrams JI, Pretto E, Angus D, Safar P: Guidelines for Rescue Training of the Lay
Public. Prehospital and Disaster Medicine, 8(2):1993.
15. 15
13. Kai T, Ukai E, Ohta M, Pretto E: Hospital Disaster Preparedness in Osaka, Japan.
Prehospital and Disaster Medicine, 9(1):1994.
14. Pretto E, Angus D, Abrams JI, et al: An Analysis of Prehospital Mortality in an
Earthquake. Pre Hosp and Disaster Med 9(2):1994.
15. Bissell R. Pretto E, Angus D, et al: Post-Preparedness Disaster Response in Costa
Rica. Pre Hosp and Disaster Med 9(2):1994.
16. Ricci E, Pretto E: Assessment of Prehospital and Hospital Response in Disaster. Crit.
Care Clinics, 7(2):471-484, 1991.
17. Comfort L, Tekin A., Pretto E, Kirimli B, Angus D. Time, Knowledge, and Action: The
Effect of Trauma Upon Community Capacity For Action. Int. Journal of Mass
Emergencies and Disasters 1998 16(1):
18. Pretto E, Safar P: National Medical Response to Mass Disasters in the United States. Are
We Prepared? JAMA 266(9):1259-1266, 1990.
19. WHO. Indonesia earthquake tsunami
20. Perkins GD, Jacobs IG, Nadkarni VM. et al. Cardiac Arrest and Cardiopulmonary Resuscitation
Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital
Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International
Liaison Committee on Resuscitation (American Heart Association, European Resuscitation
Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of
Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa,
Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular
Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and
Resuscitation. Resuscitation. 2015 Nov;96:328-40.
21. Health disaster management: guidelines for evaluation and research in the Utstein Style. Volume
I. Conceptual framework of disasters. Task Force on Quality Control of Disaster Management.
Prehospital and Disaster Medicine 2003 17; suppl 3:1-177.
22. Health disaster management: guidelines for evaluation and research in the Utstein Style.
Volume II. Structure framework, operational framework, and preparedness. Sundnes K.O.
(guest editor). Task Force on Quality Control of Disaster Management. Scand J Public
Health 2014; 42 (14 suppl): 1-195.
23. Silverman, M, Ricci, E, Gunter, M: Strategies for Improving the Rigorof Qualitative Methods in
Evaluation of Health Care Programs. Evaluation Review, Vol 14, No 1, 1990, p 57-74
24. Suchman, E: Evaluative Research. Russell SageFoundation, New York, NY, 1967
16. 16
25. Gibson, G: Guidelines for Research and Evaluation of Emergency Medical Services. Health
Services Reports, p 89-99, 1974.
26. Donabedian, A: The Definition of Quality and Approaches to Its Assessment. Health
Administration Press, AnnArbor, MI, 1980
27. Eisenberg, M and Bergner, J: Paramedic Programs and Cardiac Mortality: Description of a
Controlled Experiment. Public Health Reports, Vol 94(1), p 80-84, 1979
28. Noji, EK: Evaluation of the Efficacy of Disaster Response. UNDRO News, July/August, 1987, p
11-13
29. Domenici F., Levy J.I., Louis T.A. Methodological Challenges and Contributions in
Disaster Epidemiology. Epidemiol Review 2005; 27:9-12.
30. DeVille de Goyet C, Del Cid E, Romero E, e t a1: Earthquake in Guatemala:
Epidemiologic evaluation of the relief effort. Pan Am Hlth Org Bull., 95-109,
1976.
31. Glass RI, Um1tia JJ, Sibornys S, et al: Earthquake injuries related to housing in a
Guatemalan village. Science 197:638643, 1977.
32. Lechat MF: Disasters and Public Health. Bull. WHO 57:11-17, 1979
33. Seaman J, Leivesley C, Hogg C (eds): Epidemiology of natural disasters. Basel:
New York, Karger, 1984.
34. DeBruyker M, Greco D, Annino I, et al: The 1980 earthquake in southern Italy:
Morbidity and Mortality. Int J Epidemiol 14:113-117, 1985.
35. Binder S, Sanderson LM: The role of the epidemiologist in natural disasters. Ann
Emerg Med 16:1081-1084, 1987.
36. Deville de Goyet C, Zeballos JL: Communicable diseases and epidemiological
surveillance after sudden natural disasters. In Baskett P, Weller R (eds): Medicine for
Disasters. London, Wright, 1988, pp 252-269.
37. Gregg MB (ed): The Public Health Consequences of Disaster. Atlanta, Centers for
Disease Control, 1989.
38. Pollander GS, Rund DA: Analysis of medical needs in disasters caused by earthquake:
The need for a uniform reporting scheme. Disasters 13:365-369, 1989.
17. 17
Fig. 1. LIFE CYCLE OF A DISASTER FROM A HEALTH PERSPECTIVE
Pre-event Health Status
Event
Damage
4. Disturbances in Health Status
5. Identification of Needs
6. Responses
7. Changes in Health Status
NO 8. RestoredHealth Status?
YES
End